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Presents a letter to the editor in reply to Cognitive-Behavioral Therapy published in the 2005 issue of the "Journal of the American Academy of child and Adolescent Psychiatry."

Previously, a total of 121 children with an autism spectrum disorder (ASD) performed an adaptive working memory (WM)-training, an adaptive flexibility-training, or a non-adaptive control (mock)-training. Despite overall improvement, there were minor differences between the adaptive and mock-training conditions. Moreover, dropout was relatively high (26%). In the current study we explored potential predicting and moderating factors to clarify these findings. The effects of intelligence, autism traits, WM, flexibility, reward sensitivity and Theory of Mind on dropout, improvement during training, and improvement in everyday executive functioning (EF), ASD-like behavior, and Quality of Life (QoL) were studied. None of the predictors influenced dropout or training improvement. However, 1) more pre-training autism traits related to less improvement in EF and QoL, and 2) higher reward sensitivity was related to more improvement in QoL and ASD-like behavior. These findings suggest that these EF-training procedures may be beneficial for children with fewer autism traits and higher reward sensitivity. However, the exploratory nature of the analyses warrant further research before applying the findings clinically. [ABSTRACT FROM AUTHOR]

In adolescents with ADHD problems with attention, planning and organizing are more pronounced than in children with ADHD. However, at the same time, the parental control diminishes and greater independence is demanded. This can cause enormous distress in important areas of functioning such as school functioning, parent– adolescent interaction and can even lead to mood or disruptive disorders [1]. Since evidence-based psychosocial treatments for adolescents with ADHD are lacking and positive results have been shown for a planning and organizational training in adults with ADHD [3], we developed a cognitive-behavioral treatment for adolescents with ADHD which focuses on enhancing planning and organization skills. Restructuring of negative cognitions and motivational interviewing techniques are also included [2]. Ten adolescents, 12–16 years old, with an ADHD diagnosis and significant problems with planning and organizing participate in this study. Pre-and posttest outcomes are assessed on three domains: neuro-cognitive functioning, rating scales and ecologically valid outcome measures. Preliminary results of this pilot study are presented. Further, the design of the upcoming RCT (N = 250) is presented. [ABSTRACT FROM AUTHOR]

Problems children with ADHD experience are thought to be the result of deficits in executive functioning (EF). Spatial central executive working memory (SCE WM) has been demonstrated to be the most impaired EF in these children. Reinforcement models suggest that the poor performance of children with ADHD on EF measures is not due to an underlying EF deficit, but is caused by an altered reinforcement sensitivity. However, studies that examine this altered reinforcement sensitivity in children with ADHD show inconsistent results. These inconsistent findings may be related to the heterogeneity in the reinforcement conditions of these studies (different intensities and forms of reinforcement) [1, 2]. The present study investigates the effects of different intensities and forms of reinforcement on the SCE WM of 48 ADHD children and 48 controls aged 9–12 years. For this we use a new SCE WM task in four reinforcement conditions (feedback-only, a small amount of money (1 €), a large amount of money (10 €), and a computer game version of the task). Preliminary results of this study will be presented and implications will be discussed. [ABSTRACT FROM AUTHOR]

Long-term effects of two CBTs for adolescents with ADHD are explored: One aimed at improving planning skills (Plan My Life; PML), the other a solution-focused therapy (SFT) without focusing on planning skills. In a RCT, adolescents with ADHD ( n = 159) were assigned to PML or SFT and improved significantly between pre- and posttest with large effect sizes Boyer et al (Eur Child Adolesc Psychiatry. doi:), with marginal differences in favor of PML. One-year follow-up data were gathered. Initial improvements remained stable or continued to improve from posttest to 1-year follow-up. 25.9 % of adolescents showed normalized functioning. However, no treatment differences were found. These results are consistent with the finding that treatment of ADHD improves long-term outcomes, but not to the point of normalization. Earlier found differences at 3-month follow-up in favor of PML disappeared, indicating that focusing treatment on planning skills is not necessary for improvement or that a more prolonged planning-focused treatment is needed. [ABSTRACT FROM AUTHOR]

Adolescents with ADHD have planning problems, often affecting school- and social functioning. Evidence-based treatments for adolescents with ADHD are scarce and treatment drop-out rates are substantial. The effectiveness of two new, individual, short-term cognitive behavioral therapies (CBT) was investigated: One with an aim on improving planning skills and one solution-focused treatment (SFT) without such an aim. Motivational Interviewing elements were added to both treatments to enhance treatment compliance. In a multi-center randomized clinical trial, 159 adolescents (12-17 years) with ADHD were randomly assigned to one of both treatments. Pre-, post- and 3-month follow-up data were gathered on five domains: Parent-rated ADHD, planning problems and executive functioning (primary outcomes), neuropsychological measures of planning, comorbid symptoms, general functioning, and teacher measures. Attrition was low in both treatments (5 %). Adolescents improved significantly between pre- and post-test with large effect sizes on all domains. Improvements remained stable or continued to improve from post-test to follow-up, also when controlling for medication use. Marginally significant differences were found in favor of the planning-focused treatment: parents and therapists evaluated this treatment more positively than SFT and the planning-focused treatment showed more reduction of parent-rated planning problems. Two new CBTs with integrated motivational components were feasible and attrition was low. ADHD symptoms and co-existing problems of the adolescents improved from pre-test to 3 months after treatment. As the planning-focused treatment was evaluated more positive and had marginal additional beneficial effects to SFT, especially planning-focused CBT seems promising to fill the gap in available treatments for adolescents with ADHD. [ABSTRACT FROM AUTHOR]

Despite guidelines and repeated calls from the literature, statistical mediation analysis in youth treatment outcome research is rare. Even more concerning is that many studies that have reported mediation analyses do not fulfill basic requirements for mediation analysis, providing inconclusive data and clinical implications. As a result, after more than five decades of research, it is still largely unknown through which processes youth treatment works and what the effective treatment components are. In this article, we present ten ways in which the use of statistical mediation analysis in youth treatment outcome research may be improved. These ten ways are related both to conceptual and methodological issues. In discussing how youth clinical researchers may optimally implement these directions, we argue that studies should employ the strongest research designs possible. In so doing, we describe different levels of a mediation evidence ladder. Studies on each step of the ladder contribute to an understanding of mediation processes, but the strongest evidence for mediation is provided by studies that can be classified at the highest level. With the help of the ladder of mediation evidence, results from youth mediation treatment outcome research can be evaluated on their scientific as well as clinical impact. [ABSTRACT FROM AUTHOR]

We detected infection with highly pathogenic avian influenza A(H5N1) virus clade 2.3.4.4b in 2 red fox (Vulpes vulpes) cubs found in the wild with neurologic signs in the Netherlands. The virus is related to avian influenza viruses found in wild birds in the same area. [ABSTRACT FROM AUTHOR]

Objective The aim of the present study was to examine the moderating role of Big Five personality traits in short and long term effectiveness of MultiSystemic Therapy (MST) for serious and persistent juvenile delinquents. Method Data of a randomized controlled trial ( N = 256) were used to examine the research question. Results Extraversion, Emotional Stability and Openness did not moderate short term effectiveness of MST, but Conscientiousness and Agreeableness did: MST was most effective for highly conscientious and highly agreeable juvenile delinquents. Personality did not moderate the effectiveness of MST on aggression or the long-term effectiveness of MST. Conclusion This study shows the importance of personality traits for short-term treatment outcomes, effectiveness of MST differs for high/low Agreeableness and Conscientiousness. [ABSTRACT FROM AUTHOR]

Deficits in working memory (WM) and reinforcement sensitivity are thought to give rise to symptoms in the combined (ADHD-C) and inattentive subtype (ADHD-I) of ADHD. Children with ADHD are especially impaired on visuospatial WM, which is composed of short-term memory (STM) and a central executive. Although deficits in visuospatial WM and reinforcement sensitivity appear characteristic of children with ADHD on a group-level, the prevalence and diagnostic validity of these impairments is still largely unknown. Moreover, studies investigating this did not control for the interaction between motivational impairments and cognitive performance in children with ADHD, and did not differentiate between ADHD subtypes. Visuospatial WM and STM tasks were administered in a standard (feedback-only) and a high-reinforcement (feedback + 10 euros) condition, to 86 children with ADHD-C, 27 children with ADHD-I (restrictive subtype), and 62 typically developing controls (aged 8-12). Reinforcement sensitivity was indexed as the difference in performance between the reinforcement conditions. WM and STM impairments were most prevalent in ADHD-C. In ADHD-I, only WM impairments, not STM impairments, were more prevalent than in controls. Motivational impairments were not common (22 % impaired) and equally prevalent in both subtypes. Memory and motivation were found to represent independent neuropsychological domains. Impairment on WM, STM, and/or motivation was associated with more inattention symptoms, medication-use, and lower IQ scores. Similar results were found for analyses of diagnostic validity. The majority of children with ADHD-C is impaired on visuospatial WM. In ADHD-I, STM impairments are not more common than in controls. Within both ADHD subtypes only a minority has an abnormal sensitivity to reinforcement. [ABSTRACT FROM AUTHOR]

Highlights: [•] Predictors of treatment outcome in anxious children (N =145) were investigated. [•] Higher maternal negative affect was related to more anxiety symptoms at follow-up 3 months after treatment. [•] Lower maternal warmth was associated with more anxiety symptoms at follow-up. [•] Children higher on extraversion posttreatment had less anxiety symptoms at follow-up. [•] Fathers’ temperament and parenting style were unrelated to treatment outcome. [Copyright &y& Elsevier]

Abstract: Background: Perceived control is thought to play an important role in the development and maintenance of anxiety disorders in children. The objective of the present study was to further investigate the Perceived Control Implicit Association Procedure (IAP, ) as an indirect measure of perceived control in children. Methods: The IAP was completed by 136 anxiety disordered children (aged 8–18 years old, M = 12.51) and 31 non-selected children (8–15 years old, M = 11.65). A second control group of 38 non-selected children (aged 8–18 years old, M = 12.08) was used to validate the pictorial stimuli in the computer task. Results: First, children were able to correctly classify the pictures into Control and No control categories. Second, as predicted, anxious children reported less perceived control than the control group on both the direct measure (the ACQ-C) and the indirect measure (IAP). For the No Control score however, this was only the case for children younger than twelve years old. Third, test-retest correlation in the anxious group was fair to good (ICCs .57–.58). Conclusions: These results suggest that the perceived control IAP is still quite experimental, but could be an interesting departure point for future research on perceived control in children. [Copyright &y& Elsevier]

Objective: The present study tested the hypothesis that improvements in parental sense of competence during multisystemic therapy (MST) lead to positive changes in parenting, which in turn lead to a decrease of adolescent externalizing problems. Mediational models were tested separately for 3 dimensions of parenting (positive discipline, inept discipline, and relationship quality) that are targeted in MST. Each model included "3-path mediation," in which 2 mediators (i.e., changes in parental sense of competence and parenting dimension) intervene sequentially between the independent (i.e., intervention status) and dependent variable (i.e., change in externalizing problems). Method: Participants in this randomized controlled trial were 256 adolescents and their families who received either MST (n = 147) or treatment as usual (n = 109). In addition to pre- and postintervention assessments, 5 monthly within-intervention assessments took place. Results: Both preintervention-postintervention comparison, through analysis of covariance, and comparison of trajectories during intervention, through latent growth modeling, showed that MST enhanced growth in parental sense of competence and positive discipline, led to no deterioration in relationship quality, and resulted in a decrease in adolescent externalizing problems. The results supported a sequential pattern of change for positive discipline: Changes in parental sense of competence predicted changes in positive discipline, which in turn predicted decrease in adolescent externalizing problems. No support was found for mediated effects of inept discipline and relationship quality. Conclusions: The results affirm the importance of directly targeting parental sense of competence and positive discipline in future interventions aimed at decreasing adolescent problem behavior. [ABSTRACT FROM AUTHOR]

Abstract: Although the meta-cognitive model () for obsessive-compulsive disorder (OCD) has clearly influenced research and treatment of OCD, little research has been performed in youth samples. In the present study the psychometric properties of the Dutch Meta-Cognitions Questionnaire-Adolescent Version (MCQ-A; ) were examined in a clinical sample of adolescents with OCD (N =40, 12–18 years) and a non-clinical sample (N =317; 12–18 years). Results provided support for the 5-factor structure, and showed fair to good internal consistency and generally good retest reliability. Overall, adolescents with OCD reported more meta-cognitive beliefs than non-clinical adolescents. Several subscales were associated with self-reported obsessive-compulsive symptoms, anxiety and depression, but not with clinician-rated OCD severity. In conclusion, results suggest that the Dutch MCQ-A is a reliable and valid questionnaire to examine meta-cognitive beliefs in adolescents. [Copyright &y& Elsevier]

Abstract: To improve research in cognitive theories of childhood OCD, a child version of the Obsessive Beliefs Questionnaire (OBQ-CV) has been developed (). In the present study, psychometric properties of the Dutch OBQ-CV were examined in a community sample (N =547; 8–18 years) and an OCD sample (N =67; 8–18 years). Results revealed good internal consistency and adequate retest reliability (retest interval 7–21weeks and 6–12weeks, respectively). Children with OCD reported more beliefs than non-clinical children. Obsessive beliefs were related to self-reported OCD symptoms, but not to clinician-rated OCD severity. Beliefs were also related to anxiety and depression. This is the first study examining the factor structure of the OBQ-CV. Confirmatory factor analyses revealed best fit for four factors representing Perfectionism/Certainty, Importance/Control of Thoughts, Responsibility, and Threat, and a higher-order factor. This is in line with results from adult samples. These results support the reliability and validity of the Dutch OBQ-CV. [Copyright &y& Elsevier]

Abstract: The child version of the BIS/BAS-scales () was used to assess sensitivity of the Behavioral Inhibition and the Behavioral Activation System in clinically anxious and non-anxious youth (n =175, ages 8–18years, 70 boys). Results supported the hypothesis that clinical anxiety is associated with overactivity in the BIS (). Consistent with the revised Reinforcement Sensitivity Theory () the BIS-scale consists of two subscales, one measuring BIS_Anxiety and one measuring FFFS_Fear. BIS-scores were higher in the anxious sample than in the non-anxious sample. BAS-scores were equal. Higher levels of BIS-activity were related with an increase in symptoms of anxiety and depression. BIS-scores were higher in girls than in boys, there were no gender differences in BAS-scores. [Copyright &y& Elsevier]

Executive functioning (EF) training interventions aimed at ADHD-symptom reduction have limited results. However, EF training might only be effective for children with relatively poor EF capacity. This randomized double-blind placebo-controlled study examined whether pre-training EF capacity moderates the outcome of an EF-training intervention on measures of near transfer (EF performance) and far transfer (ADHD symptoms and parent-rated EF behavior) immediately after treatment and at 3-month follow-up. Sixty-one children with ADHD (aged 8-12) were randomized either to an EF-training condition where working memory, inhibition and cognitive flexibility were trained, or to a placebo condition. Single moderation models were used. All significant moderation outcomes had small effect sizes. After Bonferroni correction, there were no significant moderators of treatment outcome. Children with poor EF capacity do not benefit more from EF training than from placebo training. Training only EF-impaired children will probably not improve outcomes of EF training studies.

The original version of this article unfortunately contained a mistake. The captions of Figures 1 and 2 were swapped.

Background and Objectives: Excessive use of psychoactive substances and resulting disorders are a major societal problem, and the most prevalent mental disorder in young men. Recent reviews have concluded that Cognitive Bias Modification (CBM) shows promise as an intervention method in this field. As adolescence is a critical formative period, successful early intervention may be key in preventing later substance use disorders that are difficult to treat. One issue with adolescents, however, is that they often lack the motivation to change their behavior, and to engage in multisession cognitive training programs. The upcoming use of serious games for health may provide a solution to this motivational challenge., Methods: As the use of game-elements in CBM is fairly new, there are very few published studies in this field. This review therefore focuses on currently available evidence from similar fields, such as cognitive training, as well as several ongoing CBM gamification projects, to illustrate the general principles., Results: A number of steps in the gamification process are identified, starting with the original, evidence-based CBM task, towards full integration in a game. While more data is needed, some steps seem better suited for CBM gamification than others. Based on the current evidence, several recommendations are made., Limitations: As the field is still in its infancy, further research is needed before firm conclusions can be drawn., Conclusions: Gamified CBM may be a promising way to reach at risk youth, but the term "game" should be used with caution. Suggestions are made for future research., (Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: People with autism spectrum disorders (ASDs) experience executive function (EF) deficits. There is an urgent need for effective interventions, but in spite of the increasing research focus on computerized cognitive training, this has not been studied in ASD. Hence, we investigated two EF training conditions in children with ASD., Methods: In a randomized controlled trial, children with ASD (n = 121, 8-12 years, IQ > 80) were randomly assigned to an adaptive working memory (WM) training, an adaptive cognitive flexibility-training, or a non-adaptive control training (mock-training). Braingame Brian, a computerized EF-training with game-elements, was used. Outcome measures (pretraining, post-training, and 6-week-follow-up) were near-transfer to trained EFs, far-transfer to other EFs (sustained attention and inhibition), and parent's ratings of daily life EFs, social behavior, attention deficit hyperactivity disorder (ADHD)-behavior, and quality of life., Results: Attrition-rate was 26%. Children in all conditions who completed the training improved in WM, cognitive flexibility, attention, and on parent's ratings, but not in inhibition. There were no significant differential intervention effects, although children in the WM condition showed a trend toward improvement on near-transfer WM and ADHD-behavior, and children in the cognitive flexibility condition showed a trend toward improvement on near-transfer flexibility., Conclusion: Although children in the WM condition tended to improve more in WM and ADHD-behavior, the lack of differential improvement on most outcome measures, the absence of a clear effect of the adaptive training compared to the mock-training, and the high attrition rate suggest that the training in its present form is probably not suitable for children with ASD., (© 2014 Association for Child and Adolescent Mental Health.)

The purpose is to investigate whether a change in putative mediators (negative and positive thoughts, coping strategies, and perceived control over anxious situations) precedes a change in anxiety symptoms in anxiety-disordered children and adolescents receiving cognitive behavioral therapy (CBT). Participants were 145 Dutch children (8-18 years old, M = 12.5 years, 57% girls) with a primary anxiety disorder. Assessments were completed pretreatment, in-treatment, posttreatment, and at 3-month follow-up. Sequential temporal dependencies between putative mediators and parent- and child-reported anxiety symptoms were investigated in AMOS using longitudinal Latent Difference Score Modeling. During treatment an increase of positive thoughts preceded a decrease in child-reported anxiety symptoms. An increase in three coping strategies (direct problem solving, positive cognitive restructuring, and seeking distraction) preceded a decrease in parent-reported anxiety symptoms. A reciprocal effect was found for perceived control: A decrease in parent-reported anxiety symptoms both preceded and followed an increase in perceived control. Using a longitudinal design, a temporal relationship between several putative mediators and CBT-outcome for anxious children was explored. The results suggest that a change in positive thoughts, but not negative thoughts, and several coping strategies precedes a change in symptom reduction and, therefore, at least partly support theoretical models of anxiety upon which the anxiety intervention is based.

Negatively valenced thoughts are assumed to play a central role in the development and maintenance of anxiety. However, the role of positive thoughts in anxiety is rather unclear. In the current study we examined the role of negative and positive self-statements in the anxiety level of anxious and non-anxious children. Participants were 139 anxiety disordered children and 293 non-anxious children (8-18 years). Compared to non-anxious children, anxious children reported more negative thoughts, less positive thoughts and lower State of Mind (SOM) ratios (ratio of positive to negative thoughts). Negative thoughts and SOM ratios were the strongest predictors of anxiety level in anxious children; whereas both negative and positive thoughts were the strongest predictors of anxiety level in non-anxious children. To conclude, a lack of positive thoughts might be more than just an epiphenomenon of anxiety level and might deserve a place in the cognitive model of anxiety., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

The present study first examined the links between reactive temperament (negative affectivity), regulative temperament (effortful control [EC]) and internalizing problems in adolescents (12-18 years) with anxiety disorders (ANX; N = 39) and without anxiety disorders (nANX; N = 35). Links differed between ANX and nANX participants. Negative affectivity predicted internalizing problems, with almost no role of EC in nANX, but a protective role of EC was found in ANX youth. Second, we investigated the role of attentional bias as a mediator between temperament and internalizing problems. Strategic threat-related bias was predicted by initial attention and EC, but these relations differed in both groups. In nANX participants, higher initial bias scores were predictive for lower strategic bias scores and higher levels of EC were associated with higher bias scores. In ANX participants, there was almost no effect of initial bias or EC on strategic attention. Internalizing problems were predicted by strategic attention, but again differently in ANX and nANX participants. High strategic bias scores were associated with an increase in anxiety in ANX and a decrease in anxiety in nANX participants.